1 Moving Our Commonwealth Forward

2 This Is Kentucky 2

3 This Is Kentucky, Too Ranks 44 th in health status Highest smoking rate in the U.S. 1 million+ obese adults State with the highest rate of preventable hospitalizations 640,000+ Kentuckians without health insurance -Even with 2014 Medicaid expansion, uninsured will total more than 300,000 Sources: 3

4 What’s To Be Done? Call it what you wish: –Patient Protection and Affordable Care Act (PPACA) –Affordable Care Act –Obamacare –Health reform … it adds up to change. 4

5 Health Cooperatives: Born of Compromise 5 The Affordable Care Act, passed into law in March 2010, provided seed money to fund health cooperatives. Kentucky’s own Henry Clay, drawn by P.F. Rothermel (1817–1895), engraved by R. Whitechurch (1814–ca. 1880).

6 Health CO-OPs Voluntary and open membership Member-governed Member economic participation Autonomy and independence Education, training and information Cooperation among cooperatives Concern for community 6

7 Essential Health Benefits All Qualified Health Plans must include: Hospitalization Emergency services Prescription drugs Outpatient/clinic services Mental health and substance abuse services Maternity and newborn care Laboratory services Rehabilitative and habilitative services and devices Preventive/wellness services and chronic disease management Pediatric services 7

8 Kentucky Health Cooperative Licensed, nonprofit health insurance carrier. Headquartered in Louisville; serving all 120 Kentucky counties. A Consumer-Operated and Oriented Plan (CO- OP) defined under Section 1322 of the Affordable Care Act. 8

9 Kentucky Health Cooperative: DNA A fully-regulated health insurance issuer Not a federal or state agency Not to be confused with the Kentucky Health Benefit Exchange 9

10 More About Kentucky Health Cooperative Sponsored by a coalition of health care providers and business leaders Incorporated in 2011 as a nonprofit Governed by formative board of directors Charge: Meet widespread needs for greater access to affordable coverage, high quality care at lower costs 10

11 Introducing Consumers to Us Kentucky-based Board members live and work in Kentucky Journey from formation board to elected board Will offer multiple plan choices meeting a range of consumer needs represented by a diverse population 11

12 Kentucky Health Benefit Exchange It’s the online marketplace offering choice –Individuals and employees of small businesses 12

13 Premium Assistance 13

Example of Premium Assistance Amount (Family of four, varying income levels ) 14 Percent of FPL Annual Income Annual Premium Before Premium Assistance Annual Premium Assistance Amount Annual Premium After Premium Assistance Monthly Premium Before Premium Assistance Monthly Premium Assistanc e Amount Monthly Premium After Premium Assistanc e 133%$30,656$12,000$11,080$920$1,000$923$77 150%$34,575$12,000$10,617$1,383$1,000$885$ %$46,100$12,000$9,096$2,904$1,000$758$ %$69,150$12,000$6,122$5,878$1,000$510$490 Up to 400% $92,200$12,000$3,241$8,759$1,000$270$730

15 SHOP Small Business Health Options Program Own a small business? Employed by a small business? 15

16 SMALL BUSINESSES Companies with fewer than 50 workers will not be penalized if they do not provide healthcare coverage. Starting October 1, small businesses can elect to purchase insurance for their employees at any time, with coverage beginning as soon as January

17 Magic Numbers Small businesses may qualify for tax credits if : –there are less than 25 full-time employees; –average annual wage is less than $50,000, and; –employer pays at least 50% of the premium for each employee. 17

18 Example: Small Business Tax Credit 18 EmployerMain Street Mechanic Employees10 Wages$250,000 ($25,000 average per employee) Cost to employer for employee health insurance $70, tax credit$24,500 (35% credit*) 2014 tax credit$35,000 (50% credit*) * Note: Check with the IRS for applicable rate information.

19 What’s Next State Exchange went “live” on October 1 Kynect.ky.gov Carriers, plans, premiums listed –easy comparison, selection Enrollment help available throughout Ky communities Enrollment runs October 1 – March 31 Coverage starting as soon as January 1,

20 Outreach Mary Volkerding Kentucky Health Cooperative Can you lend a hand in helping spread the word? 20

21 MORE INFORMATION Kentucky Health Benefit Exchange Kentucky Health Cooperative Affordable Care Act, Health Insurance Exchanges and CO- OPs: Kaiser Family Foundation Health Insurance Marketplace